|
VENLAFAXINE 37.5 MG TABLET
|
Facility
|
OP
|
$423.70
|
|
|
Service Code
|
NDC 68084084401
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.48 |
| Max. Negotiated Rate |
$423.70 |
| Rate for Payer: Aetna Commercial |
$381.33
|
| Rate for Payer: Aetna Medicare |
$211.85
|
| Rate for Payer: ASR ASR |
$410.99
|
| Rate for Payer: ASR Commercial |
$410.99
|
| Rate for Payer: BCBS Complete |
$169.48
|
| Rate for Payer: BCBS Trust/PPO |
$346.97
|
| Rate for Payer: BCN Commercial |
$328.49
|
| Rate for Payer: Cash Price |
$338.96
|
| Rate for Payer: Cofinity Commercial |
$398.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.96
|
| Rate for Payer: Healthscope Commercial |
$423.70
|
| Rate for Payer: Healthscope Whirlpool |
$410.99
|
| Rate for Payer: Mclaren Commercial |
$381.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.14
|
| Rate for Payer: Nomi Health Commercial |
$347.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$371.25
|
| Rate for Payer: Priority Health Narrow Network |
$297.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$372.86
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
|
OP
|
$293.55
|
|
|
Service Code
|
NDC 68382001901
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.42 |
| Max. Negotiated Rate |
$293.55 |
| Rate for Payer: Aetna Commercial |
$264.20
|
| Rate for Payer: Aetna Medicare |
$146.78
|
| Rate for Payer: ASR ASR |
$284.74
|
| Rate for Payer: ASR Commercial |
$284.74
|
| Rate for Payer: BCBS Complete |
$117.42
|
| Rate for Payer: BCBS Trust/PPO |
$240.39
|
| Rate for Payer: BCN Commercial |
$227.59
|
| Rate for Payer: Cash Price |
$234.84
|
| Rate for Payer: Cofinity Commercial |
$275.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.84
|
| Rate for Payer: Healthscope Commercial |
$293.55
|
| Rate for Payer: Healthscope Whirlpool |
$284.74
|
| Rate for Payer: Mclaren Commercial |
$264.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.52
|
| Rate for Payer: Nomi Health Commercial |
$240.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$257.21
|
| Rate for Payer: Priority Health Narrow Network |
$205.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$258.32
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
|
IP
|
$2.65
|
|
|
Service Code
|
NDC 51079048001
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Aetna Commercial |
$2.38
|
| Rate for Payer: ASR ASR |
$2.57
|
| Rate for Payer: ASR Commercial |
$2.57
|
| Rate for Payer: BCBS Trust/PPO |
$2.16
|
| Rate for Payer: BCN Commercial |
$2.05
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.12
|
| Rate for Payer: Healthscope Commercial |
$2.65
|
| Rate for Payer: Healthscope Whirlpool |
$2.57
|
| Rate for Payer: Mclaren Commercial |
$2.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.25
|
| Rate for Payer: Nomi Health Commercial |
$2.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.33
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
|
IP
|
$264.96
|
|
|
Service Code
|
NDC 51079048020
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.22 |
| Max. Negotiated Rate |
$264.96 |
| Rate for Payer: Aetna Commercial |
$238.46
|
| Rate for Payer: ASR ASR |
$257.01
|
| Rate for Payer: ASR Commercial |
$257.01
|
| Rate for Payer: BCBS Trust/PPO |
$215.92
|
| Rate for Payer: BCN Commercial |
$205.42
|
| Rate for Payer: Cash Price |
$211.97
|
| Rate for Payer: Cofinity Commercial |
$249.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.97
|
| Rate for Payer: Healthscope Commercial |
$264.96
|
| Rate for Payer: Healthscope Whirlpool |
$257.01
|
| Rate for Payer: Mclaren Commercial |
$238.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.22
|
| Rate for Payer: Nomi Health Commercial |
$217.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$233.16
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
|
IP
|
$423.70
|
|
|
Service Code
|
NDC 68084084401
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$275.40 |
| Max. Negotiated Rate |
$423.70 |
| Rate for Payer: Aetna Commercial |
$381.33
|
| Rate for Payer: ASR ASR |
$410.99
|
| Rate for Payer: ASR Commercial |
$410.99
|
| Rate for Payer: BCBS Trust/PPO |
$345.27
|
| Rate for Payer: BCN Commercial |
$328.49
|
| Rate for Payer: Cash Price |
$338.96
|
| Rate for Payer: Cofinity Commercial |
$398.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.96
|
| Rate for Payer: Healthscope Commercial |
$423.70
|
| Rate for Payer: Healthscope Whirlpool |
$410.99
|
| Rate for Payer: Mclaren Commercial |
$381.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.14
|
| Rate for Payer: Nomi Health Commercial |
$347.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$372.86
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
|
IP
|
$293.55
|
|
|
Service Code
|
NDC 68382001901
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.81 |
| Max. Negotiated Rate |
$293.55 |
| Rate for Payer: Aetna Commercial |
$264.20
|
| Rate for Payer: ASR ASR |
$284.74
|
| Rate for Payer: ASR Commercial |
$284.74
|
| Rate for Payer: BCBS Trust/PPO |
$239.21
|
| Rate for Payer: BCN Commercial |
$227.59
|
| Rate for Payer: Cash Price |
$234.84
|
| Rate for Payer: Cofinity Commercial |
$275.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.84
|
| Rate for Payer: Healthscope Commercial |
$293.55
|
| Rate for Payer: Healthscope Whirlpool |
$284.74
|
| Rate for Payer: Mclaren Commercial |
$264.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.52
|
| Rate for Payer: Nomi Health Commercial |
$240.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$258.32
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
|
IP
|
$4.24
|
|
|
Service Code
|
NDC 68084084411
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$4.24 |
| Rate for Payer: Aetna Commercial |
$3.82
|
| Rate for Payer: ASR ASR |
$4.11
|
| Rate for Payer: ASR Commercial |
$4.11
|
| Rate for Payer: BCBS Trust/PPO |
$3.46
|
| Rate for Payer: BCN Commercial |
$3.29
|
| Rate for Payer: Cash Price |
$3.39
|
| Rate for Payer: Cofinity Commercial |
$3.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.39
|
| Rate for Payer: Healthscope Commercial |
$4.24
|
| Rate for Payer: Healthscope Whirlpool |
$4.11
|
| Rate for Payer: Mclaren Commercial |
$3.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.60
|
| Rate for Payer: Nomi Health Commercial |
$3.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.73
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
|
OP
|
$4.24
|
|
|
Service Code
|
NDC 68084084411
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$4.24 |
| Rate for Payer: Aetna Commercial |
$3.82
|
| Rate for Payer: Aetna Medicare |
$2.12
|
| Rate for Payer: ASR ASR |
$4.11
|
| Rate for Payer: ASR Commercial |
$4.11
|
| Rate for Payer: BCBS Complete |
$1.70
|
| Rate for Payer: BCBS Trust/PPO |
$3.47
|
| Rate for Payer: BCN Commercial |
$3.29
|
| Rate for Payer: Cash Price |
$3.39
|
| Rate for Payer: Cofinity Commercial |
$3.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.39
|
| Rate for Payer: Healthscope Commercial |
$4.24
|
| Rate for Payer: Healthscope Whirlpool |
$4.11
|
| Rate for Payer: Mclaren Commercial |
$3.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.60
|
| Rate for Payer: Nomi Health Commercial |
$3.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.72
|
| Rate for Payer: Priority Health Narrow Network |
$2.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.73
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$294.50
|
|
|
Service Code
|
NDC 00904646861
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.80 |
| Max. Negotiated Rate |
$294.50 |
| Rate for Payer: Aetna Commercial |
$265.05
|
| Rate for Payer: Aetna Medicare |
$147.25
|
| Rate for Payer: ASR ASR |
$285.66
|
| Rate for Payer: ASR Commercial |
$285.66
|
| Rate for Payer: BCBS Complete |
$117.80
|
| Rate for Payer: BCBS Trust/PPO |
$241.17
|
| Rate for Payer: BCN Commercial |
$228.33
|
| Rate for Payer: Cash Price |
$235.60
|
| Rate for Payer: Cofinity Commercial |
$276.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.60
|
| Rate for Payer: Healthscope Commercial |
$294.50
|
| Rate for Payer: Healthscope Whirlpool |
$285.66
|
| Rate for Payer: Mclaren Commercial |
$265.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$250.32
|
| Rate for Payer: Nomi Health Commercial |
$241.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$258.04
|
| Rate for Payer: Priority Health Narrow Network |
$206.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$259.16
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$268.60
|
|
|
Service Code
|
NDC 65862052790
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.44 |
| Max. Negotiated Rate |
$268.60 |
| Rate for Payer: Aetna Commercial |
$241.74
|
| Rate for Payer: Aetna Medicare |
$134.30
|
| Rate for Payer: ASR ASR |
$260.54
|
| Rate for Payer: ASR Commercial |
$260.54
|
| Rate for Payer: BCBS Complete |
$107.44
|
| Rate for Payer: BCBS Trust/PPO |
$219.96
|
| Rate for Payer: BCN Commercial |
$208.25
|
| Rate for Payer: Cash Price |
$214.88
|
| Rate for Payer: Cofinity Commercial |
$252.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.88
|
| Rate for Payer: Healthscope Commercial |
$268.60
|
| Rate for Payer: Healthscope Whirlpool |
$260.54
|
| Rate for Payer: Mclaren Commercial |
$241.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.31
|
| Rate for Payer: Nomi Health Commercial |
$220.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$235.35
|
| Rate for Payer: Priority Health Narrow Network |
$188.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$236.37
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$294.50
|
|
|
Service Code
|
NDC 00904646861
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.42 |
| Max. Negotiated Rate |
$294.50 |
| Rate for Payer: Aetna Commercial |
$265.05
|
| Rate for Payer: ASR ASR |
$285.66
|
| Rate for Payer: ASR Commercial |
$285.66
|
| Rate for Payer: BCBS Trust/PPO |
$239.99
|
| Rate for Payer: BCN Commercial |
$228.33
|
| Rate for Payer: Cash Price |
$235.60
|
| Rate for Payer: Cofinity Commercial |
$276.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.60
|
| Rate for Payer: Healthscope Commercial |
$294.50
|
| Rate for Payer: Healthscope Whirlpool |
$285.66
|
| Rate for Payer: Mclaren Commercial |
$265.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$250.32
|
| Rate for Payer: Nomi Health Commercial |
$241.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$259.16
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$268.60
|
|
|
Service Code
|
NDC 65862052790
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.59 |
| Max. Negotiated Rate |
$268.60 |
| Rate for Payer: Aetna Commercial |
$241.74
|
| Rate for Payer: ASR ASR |
$260.54
|
| Rate for Payer: ASR Commercial |
$260.54
|
| Rate for Payer: BCBS Trust/PPO |
$218.88
|
| Rate for Payer: BCN Commercial |
$208.25
|
| Rate for Payer: Cash Price |
$214.88
|
| Rate for Payer: Cofinity Commercial |
$252.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.88
|
| Rate for Payer: Healthscope Commercial |
$268.60
|
| Rate for Payer: Healthscope Whirlpool |
$260.54
|
| Rate for Payer: Mclaren Commercial |
$241.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.31
|
| Rate for Payer: Nomi Health Commercial |
$220.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$236.37
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$312.55
|
|
|
Service Code
|
NDC 00904707561
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$203.16 |
| Max. Negotiated Rate |
$312.55 |
| Rate for Payer: Aetna Commercial |
$281.30
|
| Rate for Payer: ASR ASR |
$303.17
|
| Rate for Payer: ASR Commercial |
$303.17
|
| Rate for Payer: BCBS Trust/PPO |
$254.70
|
| Rate for Payer: BCN Commercial |
$242.32
|
| Rate for Payer: Cash Price |
$250.04
|
| Rate for Payer: Cofinity Commercial |
$293.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.04
|
| Rate for Payer: Healthscope Commercial |
$312.55
|
| Rate for Payer: Healthscope Whirlpool |
$303.17
|
| Rate for Payer: Mclaren Commercial |
$281.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.67
|
| Rate for Payer: Nomi Health Commercial |
$256.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$275.04
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$312.55
|
|
|
Service Code
|
NDC 00904707561
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.02 |
| Max. Negotiated Rate |
$312.55 |
| Rate for Payer: Aetna Commercial |
$281.30
|
| Rate for Payer: Aetna Medicare |
$156.28
|
| Rate for Payer: ASR ASR |
$303.17
|
| Rate for Payer: ASR Commercial |
$303.17
|
| Rate for Payer: BCBS Complete |
$125.02
|
| Rate for Payer: BCBS Trust/PPO |
$255.95
|
| Rate for Payer: BCN Commercial |
$242.32
|
| Rate for Payer: Cash Price |
$250.04
|
| Rate for Payer: Cofinity Commercial |
$293.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.04
|
| Rate for Payer: Healthscope Commercial |
$312.55
|
| Rate for Payer: Healthscope Whirlpool |
$303.17
|
| Rate for Payer: Mclaren Commercial |
$281.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.67
|
| Rate for Payer: Nomi Health Commercial |
$256.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$273.86
|
| Rate for Payer: Priority Health Narrow Network |
$219.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$275.04
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$226.57
|
|
|
Service Code
|
NDC 00093738598
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.63 |
| Max. Negotiated Rate |
$226.57 |
| Rate for Payer: Aetna Commercial |
$203.91
|
| Rate for Payer: Aetna Medicare |
$113.28
|
| Rate for Payer: ASR ASR |
$219.77
|
| Rate for Payer: ASR Commercial |
$219.77
|
| Rate for Payer: BCBS Complete |
$90.63
|
| Rate for Payer: BCBS Trust/PPO |
$185.54
|
| Rate for Payer: BCN Commercial |
$175.66
|
| Rate for Payer: Cash Price |
$181.26
|
| Rate for Payer: Cofinity Commercial |
$212.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.26
|
| Rate for Payer: Healthscope Commercial |
$226.57
|
| Rate for Payer: Healthscope Whirlpool |
$219.77
|
| Rate for Payer: Mclaren Commercial |
$203.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.58
|
| Rate for Payer: Nomi Health Commercial |
$185.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$198.52
|
| Rate for Payer: Priority Health Narrow Network |
$158.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$199.38
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$4.64
|
|
|
Service Code
|
NDC 68084070911
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$4.64 |
| Rate for Payer: Aetna Commercial |
$4.18
|
| Rate for Payer: ASR ASR |
$4.50
|
| Rate for Payer: ASR Commercial |
$4.50
|
| Rate for Payer: BCBS Trust/PPO |
$3.78
|
| Rate for Payer: BCN Commercial |
$3.60
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cofinity Commercial |
$4.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.71
|
| Rate for Payer: Healthscope Commercial |
$4.64
|
| Rate for Payer: Healthscope Whirlpool |
$4.50
|
| Rate for Payer: Mclaren Commercial |
$4.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.94
|
| Rate for Payer: Nomi Health Commercial |
$3.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.08
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$215.73
|
|
|
Service Code
|
NDC 65862052890
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.22 |
| Max. Negotiated Rate |
$215.73 |
| Rate for Payer: Aetna Commercial |
$194.16
|
| Rate for Payer: ASR ASR |
$209.26
|
| Rate for Payer: ASR Commercial |
$209.26
|
| Rate for Payer: BCBS Trust/PPO |
$175.80
|
| Rate for Payer: BCN Commercial |
$167.26
|
| Rate for Payer: Cash Price |
$172.58
|
| Rate for Payer: Cofinity Commercial |
$202.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.58
|
| Rate for Payer: Healthscope Commercial |
$215.73
|
| Rate for Payer: Healthscope Whirlpool |
$209.26
|
| Rate for Payer: Mclaren Commercial |
$194.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.37
|
| Rate for Payer: Nomi Health Commercial |
$176.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$189.84
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$226.57
|
|
|
Service Code
|
NDC 00093738598
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.27 |
| Max. Negotiated Rate |
$226.57 |
| Rate for Payer: Aetna Commercial |
$203.91
|
| Rate for Payer: ASR ASR |
$219.77
|
| Rate for Payer: ASR Commercial |
$219.77
|
| Rate for Payer: BCBS Trust/PPO |
$184.63
|
| Rate for Payer: BCN Commercial |
$175.66
|
| Rate for Payer: Cash Price |
$181.26
|
| Rate for Payer: Cofinity Commercial |
$212.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.26
|
| Rate for Payer: Healthscope Commercial |
$226.57
|
| Rate for Payer: Healthscope Whirlpool |
$219.77
|
| Rate for Payer: Mclaren Commercial |
$203.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.58
|
| Rate for Payer: Nomi Health Commercial |
$185.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$199.38
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$215.73
|
|
|
Service Code
|
NDC 65862052890
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.29 |
| Max. Negotiated Rate |
$215.73 |
| Rate for Payer: Aetna Commercial |
$194.16
|
| Rate for Payer: Aetna Medicare |
$107.86
|
| Rate for Payer: ASR ASR |
$209.26
|
| Rate for Payer: ASR Commercial |
$209.26
|
| Rate for Payer: BCBS Complete |
$86.29
|
| Rate for Payer: BCBS Trust/PPO |
$176.66
|
| Rate for Payer: BCN Commercial |
$167.26
|
| Rate for Payer: Cash Price |
$172.58
|
| Rate for Payer: Cofinity Commercial |
$202.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.58
|
| Rate for Payer: Healthscope Commercial |
$215.73
|
| Rate for Payer: Healthscope Whirlpool |
$209.26
|
| Rate for Payer: Mclaren Commercial |
$194.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.37
|
| Rate for Payer: Nomi Health Commercial |
$176.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$189.02
|
| Rate for Payer: Priority Health Narrow Network |
$151.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$189.84
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$302.10
|
|
|
Service Code
|
NDC 00904707761
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.84 |
| Max. Negotiated Rate |
$302.10 |
| Rate for Payer: Aetna Commercial |
$271.89
|
| Rate for Payer: Aetna Medicare |
$151.05
|
| Rate for Payer: ASR ASR |
$293.04
|
| Rate for Payer: ASR Commercial |
$293.04
|
| Rate for Payer: BCBS Complete |
$120.84
|
| Rate for Payer: BCBS Trust/PPO |
$247.39
|
| Rate for Payer: BCN Commercial |
$234.22
|
| Rate for Payer: Cash Price |
$241.68
|
| Rate for Payer: Cofinity Commercial |
$283.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.68
|
| Rate for Payer: Healthscope Commercial |
$302.10
|
| Rate for Payer: Healthscope Whirlpool |
$293.04
|
| Rate for Payer: Mclaren Commercial |
$271.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.78
|
| Rate for Payer: Nomi Health Commercial |
$247.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$264.70
|
| Rate for Payer: Priority Health Narrow Network |
$211.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$265.85
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$463.60
|
|
|
Service Code
|
NDC 68084070901
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$301.34 |
| Max. Negotiated Rate |
$463.60 |
| Rate for Payer: Aetna Commercial |
$417.24
|
| Rate for Payer: ASR ASR |
$449.69
|
| Rate for Payer: ASR Commercial |
$449.69
|
| Rate for Payer: BCBS Trust/PPO |
$377.79
|
| Rate for Payer: BCN Commercial |
$359.43
|
| Rate for Payer: Cash Price |
$370.88
|
| Rate for Payer: Cofinity Commercial |
$435.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.88
|
| Rate for Payer: Healthscope Commercial |
$463.60
|
| Rate for Payer: Healthscope Whirlpool |
$449.69
|
| Rate for Payer: Mclaren Commercial |
$417.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$394.06
|
| Rate for Payer: Nomi Health Commercial |
$380.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$407.97
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$463.60
|
|
|
Service Code
|
NDC 68084070901
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.44 |
| Max. Negotiated Rate |
$463.60 |
| Rate for Payer: Aetna Commercial |
$417.24
|
| Rate for Payer: Aetna Medicare |
$231.80
|
| Rate for Payer: ASR ASR |
$449.69
|
| Rate for Payer: ASR Commercial |
$449.69
|
| Rate for Payer: BCBS Complete |
$185.44
|
| Rate for Payer: BCBS Trust/PPO |
$379.64
|
| Rate for Payer: BCN Commercial |
$359.43
|
| Rate for Payer: Cash Price |
$370.88
|
| Rate for Payer: Cofinity Commercial |
$435.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.88
|
| Rate for Payer: Healthscope Commercial |
$463.60
|
| Rate for Payer: Healthscope Whirlpool |
$449.69
|
| Rate for Payer: Mclaren Commercial |
$417.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$394.06
|
| Rate for Payer: Nomi Health Commercial |
$380.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$406.21
|
| Rate for Payer: Priority Health Narrow Network |
$324.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$407.97
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$296.40
|
|
|
Service Code
|
NDC 00904646961
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.66 |
| Max. Negotiated Rate |
$296.40 |
| Rate for Payer: Aetna Commercial |
$266.76
|
| Rate for Payer: ASR ASR |
$287.51
|
| Rate for Payer: ASR Commercial |
$287.51
|
| Rate for Payer: BCBS Trust/PPO |
$241.54
|
| Rate for Payer: BCN Commercial |
$229.80
|
| Rate for Payer: Cash Price |
$237.12
|
| Rate for Payer: Cofinity Commercial |
$278.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.12
|
| Rate for Payer: Healthscope Commercial |
$296.40
|
| Rate for Payer: Healthscope Whirlpool |
$287.51
|
| Rate for Payer: Mclaren Commercial |
$266.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.94
|
| Rate for Payer: Nomi Health Commercial |
$243.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$260.83
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$296.40
|
|
|
Service Code
|
NDC 00904646961
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.56 |
| Max. Negotiated Rate |
$296.40 |
| Rate for Payer: Aetna Commercial |
$266.76
|
| Rate for Payer: Aetna Medicare |
$148.20
|
| Rate for Payer: ASR ASR |
$287.51
|
| Rate for Payer: ASR Commercial |
$287.51
|
| Rate for Payer: BCBS Complete |
$118.56
|
| Rate for Payer: BCBS Trust/PPO |
$242.72
|
| Rate for Payer: BCN Commercial |
$229.80
|
| Rate for Payer: Cash Price |
$237.12
|
| Rate for Payer: Cofinity Commercial |
$278.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.12
|
| Rate for Payer: Healthscope Commercial |
$296.40
|
| Rate for Payer: Healthscope Whirlpool |
$287.51
|
| Rate for Payer: Mclaren Commercial |
$266.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.94
|
| Rate for Payer: Nomi Health Commercial |
$243.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$259.71
|
| Rate for Payer: Priority Health Narrow Network |
$207.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$260.83
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$4.64
|
|
|
Service Code
|
NDC 68084070911
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$4.64 |
| Rate for Payer: Aetna Commercial |
$4.18
|
| Rate for Payer: Aetna Medicare |
$2.32
|
| Rate for Payer: ASR ASR |
$4.50
|
| Rate for Payer: ASR Commercial |
$4.50
|
| Rate for Payer: BCBS Complete |
$1.86
|
| Rate for Payer: BCBS Trust/PPO |
$3.80
|
| Rate for Payer: BCN Commercial |
$3.60
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cofinity Commercial |
$4.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.71
|
| Rate for Payer: Healthscope Commercial |
$4.64
|
| Rate for Payer: Healthscope Whirlpool |
$4.50
|
| Rate for Payer: Mclaren Commercial |
$4.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.94
|
| Rate for Payer: Nomi Health Commercial |
$3.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.07
|
| Rate for Payer: Priority Health Narrow Network |
$3.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.08
|
|
